Using technique of Video-Assistant Thoracic Surgery (VATS) and small incision for diagnosis and treatment of pleura- pulmonary diseases under local anesthesia

Background. Thoracotomy is one of the hardest surgical incisions to deal with and easy leading to atelectasis or pneumonia. Investigation of minimally invasive techniques has been the major concern for surgeons. To explore the feasibility of local anesthesia in thoracotomy including minithoracotomy and Video-Assistant Thoracic Surgery (VATS) for diagnosis and treatment of Pleura-pulmonary diseases is demonstrated in this article. Methods. Forty patients under local anesthesia in surgery were divided into performing thoracotomy and non-thoracotomy as two major groups. Thoracotomy group contains two sub-group including minithoracotomy and VATS, where minithoracotomy was performed on both open and closed pneumothorax for diagnosis and treatment of pleura-pulmonary diseases. In the meantime, performing non-thoracotomy was only for local wrapped pleura diseases and chest wall diseases. Results. In minithoracotomy group, biopsy of pleura for thirteen patients were performed. Ten of them were diagnosed as metastasis, one was amyloidosis and two were proliferation of pleura. Biopsy of three of patients of diffuse pulmonary diseases resulted two cases of interstitial fibrosis and one pulmonary tuberculosis II. In the VATS group, except one patient had serious pleural adhesion with performing minithoracotomy under general anesthesia, all other cases were performed biopsy bullarectomy for recurrent pneumothorax and pleurodesis for intractable pleuaral effusion under local anesthesia. Performing diagnostic thoracoscope under local anesthesia revealed four cases of pleural effusion and one case of liver-related pleural effusion. Meanwhile, ten patients under remedial thoracoscope revealed eight cases of malignant pleural effusion with undergoing pleurodesis and two cases of recurrent pneumothorax with undergoing bullarectomy and pleurodesis as well. In the non-thoracotomy group, five cases of thoracic tuberculosis were investigated, three cases of local wrapped empyema and two cases of benign tumor of rib were found. None of severe complications and death were seen. Conclusion. Minithoracotomy and VATS under local anesthesia can be performed safely for pleural-plumonary disease and chest wall lesions, which is less cost procedure for clinical applications. [Life Science Journal. 2009; 6(2): 83 – 87] (ISSN: 1097 – 8135).